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When is my mental health disability evaluation for SSDI?

Many Social Security Disability Insurance (SSDI) claimants assume the Social Security Administration (SSA) will schedule a mental health examination and make a determination about whether or not they can qualify for disability benefits.

Unfortunately, this is not the process for approval. There is no mental health evaluation to determine disability for SSDI claimants. The Social Security Administration (SSA), instead, focuses on a claimant’s medical records from qualifying medical sources to make their SSDI disability determination and decide whether a claimant's mental health condition is so severe they cannot work.

For instance, the SSA will first look at the medical records you have in your mental health medical file. If you claim to have a severe mental health condition, the expectation is that you would have been receiving professional treatment for this condition for some time and you are following your prescribed mental health treatment plan. What types of medical information would the SSA evaluate?

• Medical notes and documentation from licensed physicians (medical or osteopathic doctors) documenting the severity of your mental health

• Medical notes from licensed or certified psychologists and psychiatrists

• Medical Reports which can include the medical history of the claimant's mental health condition, clinical findings (such as the results of physical or mental status examinations), laboratory findings (such as blood pressure, x-rays), diagnosis (statement of disease or injury based on its signs and symptoms), treatment prescribed with response, and prognosis and statements about what the claimant can still do despite their impairment.

• Medical notes from licensed counselors

If you have not received proper medical care for your severe mental health condition, the SSA could argue that with proper medical care and medication, you might be able to work at a substantial level. If you have received proper medical care for your mental health condition and you are following your doctor’s medical recommendations but you continue to have difficulty in activities of daily living, social functioning, concentration, persistence, or pace, you will have an easier time winning SSDI benefits.

What if you do not have a mental health doctor?

Given the current state of medical care in this country it is not unusual for many SSDI claimants to either not have insurance or simply not be able to afford medical care, especially if they have had to quit working.

What do you do if you are not under the condition of a professional mental health specialist? This will make it very hard to win your claim.

If you do not have sufficient medical information to prove your SSDI claim, the treating physician is not a specialist for your medical condition or your treating sources have failed to send your medical records to the SSA, the SSA will send you to a consultative examination (C.E.).

The C.E. exam should not be considered “medical care.” It is simply a cursory review of a claimant’s mental health status. The C.E. does not offer an opinion about whether the claimant is disabled or have the authority to approve SSDI benefits.

The good news is that this examination may allow some claimants to win benefits who have not had sufficient medical care. The bad news is that the C.E. exam, especially for claimants suffering from a mental health disorder, is generally insufficient to substantiate mental health conditions unless they are readily apparent. In fact, some claimants claim these examinations may last for as little as five minutes; clearly an insufficient amount of time to prove disability.

The bottom line- this cursory C.E. exam cannot possibly replace medical documentation provided by a physician who has an ongoing relationship with you. If you have not gotten medical treatment for your mental health condition it is time for a thorough, comprehensive examination
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